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As interns, residents, and clinicians we face a lot of questions related to vancomycin. In this thread I shall give a brief overview to brush up on the basics of Vancomycin dosing and therapeutic drug monitoring
Vancomycin is a tricyclic glycopeptide antibiotic that exhibits bactericidal activity. It Inhibits bacterial cell wall synthesis by blocking the glycopeptide polymerization in the bacterial cell wall.
Indications for treatment
•Methicillin resistant staphylococcus aureus
•Ampicillin resistant enterococcal infections
•Infections caused by gram positive organisms in patients who have documented history of serious allergic reaction to B-lactam antibiotics
•Methicillin resistant staphylococcus aureus
•Ampicillin resistant enterococcal infections
•Infections caused by gram positive organisms in patients who have documented history of serious allergic reaction to B-lactam antibiotics
Indications for treament Cont'
•Dialysis with serious infections caused by suspected Staphylococcal or Enterococcal infections
•Surgical prophylaxis for procedures that involve implantation of prosthetic devices or materials in patients with suspected/documented MRSA
•Dialysis with serious infections caused by suspected Staphylococcal or Enterococcal infections
•Surgical prophylaxis for procedures that involve implantation of prosthetic devices or materials in patients with suspected/documented MRSA
Loading Dose not mandatory can be givin in selected siuations
- Normal kidney function 25-30mg/kg/dose based on actual body weight (Maximum dose 2500 mg/dose)
- Intermittent hemodialysis (HD) 15-20 mg/kg/dose based on actual body weight (Maximum dose 2000 mg)
- Normal kidney function 25-30mg/kg/dose based on actual body weight (Maximum dose 2500 mg/dose)
- Intermittent hemodialysis (HD) 15-20 mg/kg/dose based on actual body weight (Maximum dose 2000 mg)
Loading Dose Cont'
-Morbidly obese patients BMI > 40 kg/m2 25-30mg/kg/dose based on actual body weight (Maximum dose 3000 mg/dose)
-Morbidly obese patients BMI > 40 kg/m2 25-30mg/kg/dose based on actual body weight (Maximum dose 3000 mg/dose)
Maintenance Dosing
Normal OR Impaired kidney function NOT on dialysis (Maximum dose 2000 mg/dose)
-Crcl>100: 15-20 mg/kg/dose every 8-12 hours
-Crcl60-99: 15-20 mg/kg/dose every 12 hours
-Crcl40-59: 10-15 mg/k/dose every 12 hours OR 15-20 mg/kg/dose every 24 hours
Normal OR Impaired kidney function NOT on dialysis (Maximum dose 2000 mg/dose)
-Crcl>100: 15-20 mg/kg/dose every 8-12 hours
-Crcl60-99: 15-20 mg/kg/dose every 12 hours
-Crcl40-59: 10-15 mg/k/dose every 12 hours OR 15-20 mg/kg/dose every 24 hours
Maintaince Dosing Cont'
-Crcl15-39: 10-15 mg/k/dose every 24 hours OR 15-20 mg/kg/dose every 48 hours
-Crcl<15 or in acute renal failure 15-20 mg/kg ONLY for one dose subsequent doses are given depending on the level of vancomycin
(HD): Depending on the level
-Crcl15-39: 10-15 mg/k/dose every 24 hours OR 15-20 mg/kg/dose every 48 hours
-Crcl<15 or in acute renal failure 15-20 mg/kg ONLY for one dose subsequent doses are given depending on the level of vancomycin
(HD): Depending on the level
Therapeutic Drug Monitoring:
-Trough levels which are drawn before giving the dose are most accurate in determining vancomycin levels
-The first trough level is normally obtained 30 mins before giving the 4th dose of vancomycin when normally vancomycin reaches steady state
-Trough levels which are drawn before giving the dose are most accurate in determining vancomycin levels
-The first trough level is normally obtained 30 mins before giving the 4th dose of vancomycin when normally vancomycin reaches steady state
Other Monitoring paraments: Renal profile, input and output.
With this we end this thread, I hope this breif overview benefits you.
With this we end this thread, I hope this breif overview benefits you.
